Redo open partial nephrectomy with ureterocalycostomy for recurrent chromophobe renal cell carcinoma: A case report of a nephron-sparing salvage strategy.

INTRODUCTION: Redo partial nephrectomy (RePN) for locally recurrent renal cell carcinoma (RCC) after prior nephron-sparing surgery (NSS) remains a challenging endeavour with limited evidence. We report a case of recurrent chromophobe RCC (ChRCC) managed by open RePN combined with reconstructive ureterocalycostomy.

MATERIAL AND METHODS: A 61-year-old hypertensive woman initially underwent right partial nephrectomy for a 1.5 × 1.2 cm lower-pole renal mass. Histopathology revealed oncocytic-variant ChRCC with indeterminate margins due to specimen fragmentation. Follow-up computed tomography (CT) at 4 months demonstrated a persistent 1.4 × 1.1 cm enhancing mass with an altered enhancement pattern and ureteric adherence, prompting redo surgery. Open RePN with ureterocalycostomy and double-J stent placement was performed through extensive adhesiolysis.

RESULTS: Histopathology confirmed focal ChRCC with negative margins (R0 resection). Post-operatively, the patient developed haemodynamic instability secondary to a urinoma (8.5 × 5.5 cm) from the renal pelvis; notably, the ureterocalycostomy remained intact. She was stabilised in the intensive care unit, and a percutaneous nephrostomy was inserted. Serum creatinine remained within normal limits throughout. Post-operative follow-up at seven weeks showed resolution of hydronephrosis on ultrasonography, and three-dimensional CT urography at 73 days demonstrated a patent collecting system with no extravasation or obstruction.

CONCLUSIONS: This case demonstrates that open RePN combined with ureterocalycostomy is a feasible nephron-sparing salvage strategy in selected patients with recurrent ChRCC and complex anatomy. The approach achieved complete tumour excision and preserved renal function. Further documentation of such reconstructive NSS techniques is warranted.